Behavioural and psychological symptoms of dementia and their management in care homes within the East of England: A postal survey

Objectives: To determine the prevalence of antipsychotic use in care homes. To explore which behaviours care home staff
can find difficult to manage and which non-pharmacological interventions are currently used within care homes to help
cope with behavioural and psychological symptoms of dementia.
Method: A postal survey sent to all care homes registered as specialising in the care of older people or/and older people
with dementia within four counties in the East of England (n ¼ 747).
Results: Questionnaires were returned from 299 care home managers (40%). The vast majority (n ¼ 200, 73%) reported
having at least one resident with an antipsychotic prescription in their home. Twelve percent (n ¼ 1027) of care home
residents were reported to be prescribed antipsychotic medications. Aggression was most frequently reported, by 37%
(n ¼ 109) of care home managers, as a difficult behaviour to manage. Non-pharmacological interventions were reported to
be used in 87% (n ¼ 253) of care homes. The interventions most commonly used in care homes to manage difficult
behaviours were reminiscence (75%, n ¼ 219) and music therapy (73%, n ¼ 213).
Conclusion: This survey was a first attempt to estimate the use of antipsychotics in care homes. Despite measures to reduce
antipsychotic use for all people with dementia in England, we found that 12% of care home residents were still prescribed
antipsychotic medication. Around half of all care home managers reported they had experienced behaviours they found
difficult. Antipsychotic medications and a variety of non-pharmacological interventions appear to be used concurrently in
many care homes.